This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Our GENERAL HYPOTHESIS is that women with GDM are at higher risk for developing more severe periodontal disease than women without GDM and that the combination of GDM and periodontal disease will be associated with an increased negative impact on maternal and fetal health. These prospective clinical data will be correlated with basic science laboratory evaluations of the microflora and host response to provide insight into the pathogenic mechanisms contributing to negative maternal and fetal outcomes associated with inflammatory periodontal disease and GDM. This project consists of three specific aims that are designed to study the effects of Gestational Diabetes Mellitus (GDM) on the clinical, microbiologic and immunologic characteristics of periodontal disease and the associations between these potential risk factors and maternal and fetal health. At enrollment, the investigator performs a clinical periodontal examination to document the presence and severity of periodontitis (Specific Aim 1). Patients who are enrolled early in their pregnancy (31 weeks), may only be seen for one visit. Comparable examinations are performed on the controls without GDM, who have been matched with the test subjects for age, race/ethnicity and gestational week. The subjects are stratified into four groups based on diabetic status and the presence or absence of periodontitis [unreadable]Group 1: GDM with periodontitis (GDM + PD);Group 2: GDM without periodontitis (GDM [unreadable]PD);Group 3: normal controls with periodontitis (NC + PD);and Group 4: normal controls without periodontitis (NC [unreadable]PD). In addition to performing the clinical examinations, dental plaque and serum samples are collected as part of the baseline and 34 week examinations, allowing us to characterize the subgingival biofilm microbiota (Specific Aim 2) and quantify levels of systemic inflammatory biomarkers (Specific Aim 3) in each group and at each time point. The study population consists of a group of ambulatory women, aged 16-45, whose pregnancies are being managed through the University of Kentucky Clinics, the Gordon and Salter, Inc. practice in Richmond, KY and the Georgetown Obstetrics and Gynecology practice in Georgetown, KY. We have currently enrolled 271 subjects into the following categories: GDM + PD 56;GDM [unreadable]PD 83;NC + PD 42;NC [unreadable]PD 90. The ethnic/racial profiles are 100 White, 120 Hispanic/Latino, 29 Black/African American and 22 Asian. All of the data, including maternal and fetal outcomes, have been collected on 230 of these subjects.